Yonsei Med J.  2013 Jan;54(1):123-130. 10.3349/ymj.2013.54.1.123.

Correlations of Dynamic Contrast-Enhanced Magnetic Resonance Imaging with Morphologic, Angiogenic, and Molecular Prognostic Factors in Rectal Cancer

• Hong HS
• Kim SH
• Park HJ
• Park MS
• Kim KW
• Kim WH
• Kim NK
• Lee JM
• Cho HJ

• KMID: 1776927
• DOI: http://doi.org/10.3349/ymj.2013.54.1.123

Abstract

PURPOSE
To investigate the correlations between parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and prognostic factors in rectal cancer.
MATERIALS AND METHODS
We studied 29 patients with rectal cancer who underwent gadolinium contrast-enhanced, T1-weighted DCE-MRI with a three Tesla scanner prior to surgery. Signal intensity on DCE-MRI was independently measured by two observers to examine reproducibility. A time-signal intensity curve was generated, from which four semiquantitative parameters were calculated: steepest slope (SLP), time to peak (Tp), relative enhancement during a rapid rise (Erise), and maximal enhancement (Emax). Morphologic prognostic factors including T stage, N stage, and histologic grade were identified. Tumor angiogenesis was evaluated in terms of microvessel count (MVC) and microvessel area (MVA) by morphometric study. As molecular factors, the mutation status of the K-ras oncogene and microsatellite instability were assessed. DCE-MRI parameters were correlated with each prognostic factor using bivariate correlation analysis. A p-value of <0.05 was considered significant.
RESULTS
Erise was significantly correlated with N stage (r=-0.387 and -0.393, respectively, for two independent data), and Tp was significantly correlated with histologic grade (r=0.466 and 0.489, respectively). MVA was significantly correlated with SLP (r=-0.532 and -0.535, respectively) and Erise (r=-0.511 and -0.446, respectively). MVC was significantly correlated with Emax (r=-0.435 and -0.386, respectively). No significant correlations were found between DCE-MRI parameters and T stage, K-ras mutation, or microsatellite instability.
CONCLUSION
DCE-MRI may provide useful prognostic information in terms of histologic differentiation and angiogenesis in rectal cancer.

Keyword

Colorectal neoplasms; prognosis; diagnostic imaging; magnetic resonance imaging

MeSH Terms

Adult
Aged
Aged, 80 and over
Cell Differentiation
Contrast Media/*pharmacology
DNA Mutational Analysis
Female
Gadolinium/pharmacology
Genes, ras
Humans
Magnetic Resonance Imaging/*methods
Male
Microcirculation
Microsatellite Instability
Middle Aged
Neoplasm Staging
Neovascularization, Pathologic
Prognosis
Rectal Neoplasms/*diagnosis/genetics/*pathology
Retrospective Studies
Time Factors
Contrast Media
Gadolinium

Figure

• 

  Fig. 1 Measurement of DCE-MRI. (A) On DCE-MRI, a ROI was freely drawn within the tumor to encompass the largest area of enhancement. (B) A time-signal intensity curve was generated at a workstation using commercially available software. DCE-MRI, dynamic contrast-enhanced magnetic resonance imaging; ROI, region of interest.

• 

  Fig. 2 Semiquantitative parameters of DCE-MRI in time-signal intensity curve. SLP is the steepest slope between two time points. Tp is time to peak enhancement. Relative enhancement during a rapid rise (Erise)=signal intensity during the rise (SIrise)-the mean signal intensity value during the initial five time points (SIbase). The maximum relative enhancement (Emax)=the highest signal intensity value in a curve (SImax)-SIbase. SI, signal intensity; Tp, time to peak; SLP, steepest slope; DCE-MRI, dynamic contrast-enhanced magnetic resonance imaging.

• 

  Fig. 3 Morphometric study of microvessels. Microvessels were immunostained using a CD31-related antigen-specific mouse monoclonal antiboy. (A) A photomicrograph (200×) of a hot spot in a representative tumor section shows immunostained microvessels (arrows) in brown. (B) Microvessels are highlighted by a color threshold setting to distinguish the objects of positive staining from the counter-stained background tissue.

• 

  Fig. 4 DNA sequencing analysis of the K-ras gene. PCR products encompassing codons 12 and 13 of exon 2 were analyzed to confirm mutations. An overlap (arrow) of black G- and red T peaks at codon 12 is shown, representing a substitution of valine for glycine with G to T transversion. PCR, polymerase chain reaction.

• 

  Fig. 5 A plot of electrophoregram analysis of microsatellite instability. The data of normal control (upper row) and tumor tissue (lower row) are displayed as base-pair size displayed on the x-axis against peak signal intensity in relative fluorescent units on the y-axis. A single, small peak (arrow) is additionally seen in tumor only with D17S250 marker, representing low-frequency of microsatellite instability (MSI-low).

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